Smokers' biology affects their chances of quitting with or without medication. Published on September 25, 2012 by Adi Jaffe, Ph.D. in All About Addiction Here at A3 we're big supporters of scientific progress in addiction treatment. It may be true that addicts need to want recovery in order to truly turn their lives around, but the choice is hardly ever that simple. If we can tip the balance in favor of treatment, or a better way of life, I say let's go for it. When it comes to genetics and addiction, I've normally talked only about the fact that one's genetic code may predispose him or her to addiction or other related conditions (likedepression and anxiety). Aside from a single mention of pharmacogenomics, I don't think I've spoke about the way genetics can help us tailor addiction treatment. We're about to fix that. Replacement therapies and quitting smokingYou've heard of nicotine patches and gums, right? In the research community, those are all known as nicotine replacement (NR) therapies and they've proven to be some of the most helpful tools for those who are quitting smoking. By allowing smokers to still get the nicotine their body craves (even though there are thousands of other chemicals incigarettes that make them even more satisfying) without having to light up, these NR methods let cigarette addicts get their nic fix while slowly lowering their dose and getting away from the habit of putting a cigarette in their mouth. Like methadone, buprenorphine, and other replacement therapies, the idea is to move addicts one step away from actual addictive behavior and allow them to adopt a healthier way of living. Replacement therapies are successful, even if some people hate the idea of giving drugs to drug addicts, and nicotine replacement works well by itself for some smokers (about 20 percent). But when it comes to nicotine, like with many other drugs, different people metabolize the stuff at different rates. The individual variability in the internal processing of nicotine greatly affects how many cigarettes individuals smoke and also the probability that they will become addicted to tobacco (people who metabolize nicotine more quickly smoke more and are more likely to become addicted to smoking). Fast metabolizers are also half as likely to be able to use nicotine replacement alone to quit smoking (1). Fortunately for smokers, the only research finding in this area hasn't been that slow metabolizes have a much better chance of quitting smoking with nicotine replacement therapy. When you put all of the addiction research together, it becomes obvious that the same variability in nicotine metabolism can also help us determine the best course of treatment for tobacco addiction. The same group of addiction researchers also found that buporopion, the smoking cessation medication everyone knows as Zyban (and the antidepressantcalled Wellbutrin), could help those fast metabolizers catch up with the slow metabolizers when it came to quitting (see the figure on the left taken from the actual study—you see that the dark bars, who are the bupropion patients, do as well as the white bars, the slow metabolizers, regardless of their metabolism rate, which is broken down into four categories on the bottom). The researchers found that while slow matabolizers of nicotine did much better with simple smoking cessation therapy and fast metabolizers did very poorly (30 percent versus 10 percent quit, respectively, in each of the groups), adding bupropion made all groups look essentially the same (2). The moral? While those slow metabolizers don't really get much of a benefit from using bupropion since they do pretty well with talk therapy or nicotine replacement alone, the fast metabolizers really need it to even their chances of quitting—and once they get bupropion, they do pretty well! Genetics and addiction treatment—just the beginning?Hopefully you're now convinced that genetics can really help us determine what treatment course will best suit a specific person over another. There's little question that this sort of approach is in its infancy, and you certainly can't go to a doctor right now and get your metabolism rate for a drug analyzed (unless you're part of a research study), but this sort of work shows great promise in improving the outcomes of addiction treatment. When you look back at that original paragraph, and the quite common thinking that addicts need to want to be better—I would argue that those fast metabolizers probably wanted to quit smoking as much as anyone else in the study, and their physical makeup just made it much more difficult for them. If you look at addiction science closely, you'll find that this supposed lack-of-motivation is more of a myth than a reality. Many addicts want to get better, they want to stop behaving in ways that destroy their lives but they just find it incredibly difficult. My hope is that this is where science can truly make a difference, by making it just a little bit easier... Hopefully one day we'll be able to adjust addiction treatment according to individual patients' needs, including the use of medications, specific behavioral treatments, and more. Citations: 1) RA Schnoll, F Patterson, EP Wileyto, RF Tyndale, N Benowitz, & C Lerman. Nicotine metabolic rate predicts successful smoking cessation with transdermal nicotine: A validation study (2009). 2) F Patterson, RA Schnoll, EP Wileyto, A Pinto, LH Epstein, PG Shields, LW Hawk, RF Tyndale, N Benowitz& C Lerman1. Toward Personalized Therapy for Smoking Cessation: A Randomized Placebo-controlled Trial of Bupropion (2008). For this back-to-school season, I would like to offer some advice about one of the most frequent problems presented to me in over 30 years of clinical practice: battles over homework. I have half-jokingly told many parents that if the schools of New York State no longer required homework, our children’s education would suffer (slightly). But, as a child psychologist, I would be out of business. Many parents accept this conflict with their children as an unavoidable consequence of responsible parenting. These battles, however, rarely result in improved learning or performance in school. More often than not, battles over homework lead to vicious cycles of nagging by parents and avoidance or refusal by children, with no improvement in a child’s school performance — and certainly no progress toward what should be our ultimate goals: helping children enjoy learning and develop age-appropriate discipline and independence with respect to their schoolwork. Back to School It's that time again. Before I present a plan for reducing battles over homework, it is important to begin with this essential reminder: The solution to the problem of homework always begins with an accurate diagnosis and a recognition of the demands placed on your child. Parents should never assume that a child who resists doing homework is “lazy.” Every child whose parents or teachers report ongoing resistance to completing schoolwork or homework; every child whose performance in school is below expectations based on his parents’ or teachers’ intuitive assessment of his intellectual potential; and every child who, over an extended period of time, complains that he “hates school” or “hates reading,” should be evaluated for the presence of an attention or learning disorder. These children are not lazy. Your child may be anxious, frustrated, discouraged, distracted, or angry — but this is not laziness. I frequently explain to parents that, as a psychologist, the word lazy is not in my dictionary. Lazy, at best, is a description, not an explanation. For children with learning difficulties, doing their homework is like running with a sprained ankle: It is possible, although painful, and he will look for ways to avoid or postpone this painful and discouraging task. A Homework Plan Homework, like any constructive activity, involves moments of frustration, discouragement, and anxiety. If you begin with some appreciation of your child’s frustration and discouragement, you will be better able to put in place a structure that helps him learn to work through his frustration - to develop increments of frustration tolerance and self-discipline. I offer families who struggle with this problem a Homework Plan: • Set aside a specified — and limited — time for homework. Establish, early in the evening, a homework hour. • For most children, immediately after school is not the best time for homework. This is a time for sports, for music and drama, and free play. • During the homework hour, all electronics are turned off — for the entire family. • Work is done in a communal place, at the kitchen or dining room table. Contrary to older conventional wisdom, most elementary school children are able to work more much effectively in a common area, with an adult and even other children present, than in the “quiet” of their rooms. • Parents may do their own ”homework” during this time, but they are present and continually available to help, to offer encouragement, and to answer children’s questions. Your goal is to create, to the extent possible, a library atmosphere in your home, again, for a specified and limited period of time. Ideally, therefore, parents should not make or receive telephone calls during this hour. And when homework is done, there is time for play. • Begin with a reasonable — a doable — amount of time set aside for homework. If your child is unable to work for 20 minutes, begin with 10 minutes. Then try 15 minutes the next week. Acknowledge every increment of effort, however small. • Be positive and give frequent encouragement. Make note of every improvement, not every mistake. • Be generous with your praise. Praise their effort, not their innate ability. But do not be afraid of praise. • Anticipate setbacks. After a difficult day, reset for the following day. • Give them time. A child’s difficulty completing homework begins as a problem of frustration and discouragement, but it is then complicated by defiant attitudes and feelings of unfairness. A homework plan will begin to reduce these defiant attitudes, but this will not happen overnight. Most families have found these suggestions helpful, especially for elementary school children. Establishing a homework hour allows parents to move away from a language of threats (“If you don’t ... you won’t be able to ...”) to a language of opportunities (“When” or “As soon as” you have finished ... we’ll have a chance to ...”). Of course, for many hurried families, there are complications and potential glitches in implementing any homework plan. It is often difficult, with children’s many activities, to find a consistent time for homework. Some flexibility — some amendments to the plan — may be required. But we should not use the complications of scheduling or other competing demands as an excuse, a reason not to establish the structure of a reasonable homework routine. Copyright Ken Barish, Ph.D. Ken Barish is the author of Pride and Joy: A Guide to Understanding Your Child’s Emotions and Solving Family Problems. By E & E Staff Oftentimes while speaking at forums I've encountered men and women who struggle with the age old of question of how to find the right mate and are in search of some type foolproof advice on what to do. Though I believe that it is great to carry an optimistic attitude while looking for what may be a future wife or husband, individuals must keep realistic and clear cut expectations of the people that they choose to date. One of the best ways to get to the heart of finding out if a person fits those expectations is to ask the questions you REALLY want to know ("dealbreakers") within the first two-four weeks of meeting your potential mate. To build a relationship that has effective communication is not easy but many people that I speak to seem to want to make it a lot harder than it has to be. Many of the couples that I see in therapy go months (and sometimes years) participating in relationships without truly knowing the answers to questions that could've possibly be "dealbreakers" for them. Below I've compiled a list of 5 common questions that women should ask but often don't because they are to scared to or just plain assume the answer. Though the title is framed as giving women advice, these questions work well for either sex in most any kind of romantic relationship. Hopefully, these suggestions can help you along in your quest for effective communication with your mate. Keep in my mind that this is only a list of suggestions (, not law....) based on the experiences I've had giving couples therapy. 1. Do you have kids? If not, do you eventually want to have them and if so, do you want to have more? - In today's day and age this is a must ask within the first two weeks of meeting someone. 2. When was your last relationship and do you still communicate with that person/those people? -This is a question that a man would normally ask of a woman if he is truly and seriously interested in her so why not return the favor? 3. What do you do for a living and where do you see yourself in the next five years professionally and financially? - This question seems to be one of concern to many women but also a question that they may be scared to ask right away. I say go for it when the time is right but do not wait too long. If you can't see yourself happy sitting amongst his ideal plan then break it off sooner than later. 4. What kind of relationship do you have with your parents? - A good question to know because it often is a good indicator of shared morals. 5. Do you believe in marriage and have you ever been married before? - A common question that is glossed over because of assumption. ASK! While some of these questions may seem like common sense, many people dance around these topics or make assumptions based on inferences. Another common occurance I have seen is that many times women believe that they can train their mate to adopt their beliefs. While I wouldnt suggest asking these questions on a first date, I have found that if a man truly interested in a woman then engaging in these topics of conversation isn't is awkward for him as one might think. Remember, when a man shows anxiety during a topic of discussion it may just mean that he's just not that into you. Proceed with caution but show courage and get to heart of the topics you really want to know! For further discussion contact Dr. Robert's Twitter page at @DrRobertCEvans Published on Psychology Today (http://www.psychologytoday.com) By Dr. Shauna H. Springer Created Sep 1 2012 - 8:08am The plan for today is to make an argument that fighting before marriage is a good thing. Does this sound counter-intuitive? Here are my arguments. Some people see fighting as a sign of fundamental incompatibilities. They are right. The thing is that we are all incompatible on some levels, and it’s delusionary to think otherwise. The first phase of any romantic relationship, which I have referred to as the “cocaine-rush” phase (see my former blog entry from August 4, 2012: “Falling in Love is Like SmokingCrack Cocaine”), is a period of untested fantasies of being the “perfect match” for each other. Perfect match fantasies will be reliably tested during the second phase of a romantic relationship, which I identify and describe in my book as the “Testing” phase. Pamela Paul, author of the well-researched book The Starter Marriage and the Future of Matrimony, suggests that “a typical marriage follows a certain course. The first year is the hardest, as the saying goes.”* In my role as a marital counselor, I often hear that the first two years of marriage are experienced in one of two extreme ways. That is, some couples experience consistent moments of sublime bonding that lead others to observe that they have “that newlywed glow,” while other couples acknowledge that the first two years were “a rough transition.” I would hypothesize that a major reason for this distinction is that some couples marry too soon, while they are still in the cocaine-rush phase of their relationship. When couples marry during the cocaine-rush phase, they can predictably expect to go through the tunnel of stress and chaos that is the entry into the “Testing” phase at some point soon after they are married. Other couples, who have had a longer, less impulsive, more thoughtful courtship, have already passed through the transition between the cocaine-rush phase and the testing phase. They have a much better idea of who they are marrying and are much less likely to experience major disillusionment after marriage. So, the presence of fighting before marriage often signals that a couple has probably transitioned (or is transitioning) into the “Testing” Phase of a relationship. Compatibility of personality, beliefs, core values, and goals shows up with greater clarity during conflict. One hallmark of the cocaine-rush phase is that both partners selectively filter for evidence that each is the “perfect match” for the other. Lovers in the first stage of a relationship often highlight similarities and minimize differences. If differences do not come to light before a couple marries, the risk for post-marital disillusionment and dissolution is higher. If sources of incompatibility and disagreement can come up before marriage, then each partner will have an opportunity to decide whether particular differences are ones he or she can live with or whether there are deal-breaker differences. Fighting before marriage also allows each partner to gain a rich source of information about the process of how you fight and whether you can learn to have conflict without weakening your bond. Only in the context of conflict will you be able to see whether each of you can do things like… • Manage and de-escalate your own negative emotions • Understand each other’s perspective even when you don’t agree • Treat each other with basic respect in the heat of conflict • Strengthen your bond through the process of post-conflict insight and repair • Come to new understandings of yourselves and your relationship in a way that deepens intimacy Essentially, conflict tests character. How you work through problems is in many cases even more important than the actual issue(s) you resolve. Successful couples show core respect, recognize the validity of each other’s thoughts and feelings, and make generous attributions for each other’s behavior.** So, specifically, ask yourself, on the far side of a conflict, do you both feel heard and respected? Does each of you feel like you had influence on the other person and on the decided outcome? Being mindful of how the process of conflict feels is critical to assessing the true potential of a developing love relationship. Depending on how it is handled, conflict can be a powerful catalyst for growth. The context of conflict also allows you to evaluate whether a potential partner is fundamentally trustworthy. Conflict plays a central role in trust-building process in several different types of close relationships. For example, in therapy, a slight rupture followed by a repair of the treatment alliance often leads to a much stronger relationship. I think this is because ruptures and repairs give us critical sources of information about how much we can trust each other to stay connected, show respect, and stick it out when the going is rough. In addition to assessing trustworthiness, there is the bigger question of whether you can trust yourselves as a couple to weather the storms that will come. Theorists and researchers refer to this as relationship self-efficacy. In other words, do you, as a couple, feel confident that you can work through conflict productively? This may seem obvious, but it's a very important point: You can’t know the answer to this question without having had some conflict. A major reason to wait out the cocaine-rush phase of the relationship is to date each other long enough so you can weather a few storms before you take the final plunge together. In fact, I strongly recommend that couples in the pre-marital phase of their relationship proactively ask each other lots of hard questions to set off some hidden land mines before they consider marriage. Couples that set off some land mines up front benefit from some of the protection that comes from the tendency to idealize each other in the first stage of love. Motivation to overcome barriers and find common ground is typically at peak levels before two people are legally bound to each other. Probable areas of future conflict can be identified and respectful rules of engagement can be developed. Two people who go into their marriage knowing that they can stay connected despite conflict have a much better chance of staying married. So, fighting before marriage is indeed a very good thing. * Paul, P. (2002). The Starter Marriage and the Future of Matrimony. New York: Villard Books, p. 100. ** Koren, P., Carlton, K., and Shaw, D. (1980). "Marital Conflict: Relations Among Behaviors, Outcomes, and Distress. Journal of Consulting and Clinical Psychology, 48, 460-468. Source URL: http://www.psychologytoday.com/node/105159 |
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